Correlation of abnormal umbilical artery Doppler Indices and mode of delivery in intrauterine growth restriction

Abstract

Background: Elevated impedance to blood flow in the placenta is reflected by abnormal umbilical artery (UA) indices as seen in intrauterine growth restriction (IUGR). Aims: To correlate abnormal UA Doppler velocimetry parameters with birth weight and mode of delivery in IUGR. Material and Methods: A prospective study was conducted in Department of Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and Child, IGMC Shimla HP, over a period of one year from August 2017 to July 2018. The study included a total of 120 consecutive clinically suspected cases of singleton IUGR pregnancies, at 34–40 weeks of gestation. Umbilical artery (UA) Doppler indices including systolic/diastolic (S/D) ratio, pulsatility index (PI), and resistive index (RI) were measured. The decision regarding mode delivery was based on absent or reversal of diastolic flow, abnormal fetal heart tracing, and other maternal and fetal conditions, e.g., preeclampsia or abnormal biophysical profile. The birth weight, mode of delivery, and the reasons for emergency cesarean section were noted. Statistical analysis was performed using Statistical Package for Social Sciences, version 16.0 and a P value <0.05 was considered statistically significant. Results: Abnormal UA PI (>1.42) was seen in 24 fetuses. Among these, 69% (n = 16) underwent a cesarean delivery, and 91% (n = 22) had a birth weight less than 2.5 kg. Statistically significant association was noted with abnormal UA PI (P-value: <0.01), abnormal UA RI (P-value: <0.001), and abnormal UA S/D (P-value: <0.001) and cesarean delivery. The main indication for cesarean section was fetal distress. Conclusion: Abnormal UA Doppler indices are significantly associated with cesarean deliveries and low birth weight babies.